Description
At the University of California, San Francisco (UCSF), pediatric residents who have completed their first year of full-time residency training can take a “flexible option,” in which they work six to eight months a year and are permitted to take up to five years to complete their training. Although the residency program does not pay a salary during time off, all flexible option residents are covered by disability insurance, workman’s compensation, and medical malpractice benefits, and those choosing the flexible option for maternity or dependent care reasons are also covered by medical insurance. Similarly, the UK’s Flexible Training Scheme offers a part-time training option. Also referred to as less than full-time (LTFT) training, the option may be granted (with an application) for reasons such as ill health, disability, caregiving responsibilities, or professional development opportunities. The total time in and quality of training must be the same for all trainees, whether they are on a full-time or LTFT schedule, although LTFT trainees must work at least 50% time.
At McMaster University in Canada, family medicine residents can have flexible rotations with a lighter workload at the beginning of their return from parental leave. Residents on maternity leave can work part-time and “bank” hours to take time off when they return. Many residents work two half-days each week in activities such as tutorials and clinical care and then return to a full-time schedule within a few weeks of giving birth.
Several strategies exist to compensate for the shifts in workloads. UCSF structures salaries such that they are combined across multiple flexible option residents. The UK National Health Service (NHS) offers a variety of mechanisms, including: slot-sharing, in which two doctors work on a LTFT basis under one full-time position; emergency short-term flexible arrangements; permanent flexible posts, if funding allows; study leave and return to work from maternity; and pay structures that do not create financial disincentives for NHS facilities/health care systems to accept LTFT trainees.
Implementation lessons learned
Informal assessments at these universities indicate that flexible training schedules are helpful to medical residents. Institutions considering implementing this practice should anticipate possible financial constraints as well as the perceptions of residents whose workloads may be affected. UCSF residents, who do not receive a salary during their flexible option time off, cited financial concerns as the primary reason for not taking the flexible option. Residents applying for LTFT placements in the UK NHS may also face challenges because of the financial resources needed by the training authorities.
In addition, a study of the UCSF flexible option found that 12% of residents “somewhat resented the participation of other residents in the [flexible option]” because of the increased workload for fellow residents, although some of these workload changes may also have been due to other departmental needs. However, despite these concerns, most UCSF residents, both flexible-option and regularly-scheduled, support the practice.
Program planners must raise awareness of the flexible training option. For example, from 1994-1999, only one McMaster University family medicine resident took the part-time option.
Example
Information on UK National Health Service less than full-time training
Additional information: PDF